| NPI | 1902938426 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY24611) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 103T00000X Psychologist (Licence: CA PSY 24611) | |
| 106H00000X Marriage & Family Therapist (Licence: CA 35241) | |
| Enumeration Date | 2007-03-10 |
| Last Update Date | 2014-08-26 |